Management of Small Cell Lung Cancer: Radiotherapy

Radiotherapy
In limited stage SCLC, thoracic RT is generally accepted as an essential component of optimal management. However, many aspects of RT delivery remain less than adequately defined, including sequencing, timing, fractionation, dose, and field size.RT Sequencing
Chemotherapy and RT can be administered concurrently, sequentially, or in an alternating manner. To date, randomized trials have failed to adequately determine the optimal sequence in which these two modalities should be delivered. Using cisplatin-based chemotherapy, Takada and colleagues reported an impressive survival advantage for concomitant RT compared with RT delivered sequentially following completion of the same chemotherapy. Gregor et al, reporting for the European Organization for Research and Treatment of Cancer, found no difference in survival when RT was delivered in a sequential or alternating manner with cyclophosphamide-based chemotherapy. Similarly, French investigators observed no survival advantage for concomitant RT over alternating RT in a recently completed randomized trial that also employed cyclophosphamide-based chemothera-py. canadian neighbor pharmacy viagra
Based on these and other data, one can conclude that concurrent therapy is associated with improved survival but at a cost of increased toxicity, especially if administered with cyclophosphamide-based chemotherapy regimens. However, if RT is administered concomitantly with PE, the long-term toxicities appear to be relatively modest. Short-term toxicity consists primarily of esophagitis, which is manageable. Given the survival advantage associated with concomitant PE and RT, these toxicities seem acceptable.RT Timing
The early administration of RT could potentially eliminate localized populations of chemotherapy-resistant tumors cells that might be responsible for treatment failure if permitted to disseminate systemically. If true, this would be an obvious advantage for early administration of RT.